The Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses: Definitions, Criteria, and Explanatory Notes for Terminology and Specimen Adequacy

80 Pages·1994·2.82 MB·English

by  Robert J. Kurman

The Bethesda
System
Robert J. Kurman
Diane Solomon
The Bethesda
System
for Reporting
Cervical/Vaginal
Cytologic Diagnoses
Definitions, Criteria, and Explanatory
Notes for Terminology and
Specimen Adequacy
With 61 color illustrations
Springer-Verlag
New York Berlin Heidelberg London Paris
Tokyo Hong Kong Barcelona Budapest
Robert J. Kunnan Diane Solomon
Johns Hopkins University National Cancer Institute
School of Medicine Bethesda, MD 20892
Baltimore, MD 21287 USA
USA
Library of Congress Cataloging-in-Publication Data
The Bethesda system for reporting cervical/vaginal cytologic diagnoses
: definitions, criteria and explanatory notes for terminology and
specimen adequacy / Robert Kurman, Diane Solomon.
p. cm.
ISBN-13: 978-0-387-94077-9 e-ISBN-13: 978-1-4684-0201-8
DOl: 10.1007/978-1-4684-0201-8
1. Cervix uteri-Cytopathology-Terminology. 2. Vagina
-Cytopathology-Terminology. 3. Cervix uteri-Diseases-
-Cytodiagnosis-Terminology. 4. Vagina-Diseases-Cytodiagnosis-
-Terminology. I. Kurman, RobertJ.
[DNLM: I. Cervix Diseases-diagnosis. 2. Cervix Diseases
-classification. 3. Vaginal Diseases-diagnosis. 4. Vaginal
Diseases-classification. 5. Cytodiagnosis-methods.
6. Cytological Techniques. WP 470 B562 1993]
RG3IO. B48 1993
618. I' 407-dc20
DNLMlDLC 93-31572
Printed on acid-free paper.
@ 1994 Springer-Verlag New York, Inc.
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Contents
Contributors vii
Introduction ix
Part 1
Specimen Adequacy: Definitions, Criteria, and
Explanatory Notes 3
Background 4
Patient and Specimen Identification 4
Pertinent Clinical Information 4
Technical Interpretability 5
Cellular Composition and Sampling of the
Transformation Zone 5
Definitions and Criteria for Specimen Adequacy 6
Part 2
Descriptive Diagnoses: Definitions, Criteria, and
Explanatory Notes 9
Benign Cellular Changes 12
Infection 12
Trichomonas vaginalis 12
Fungal organisms morphologically consistent with
Candida spp. 12
Predominance of coccobacilli consistent with shift in vaginal
flora 14
Bacteria morphologically consistent with Actinomyces spp. 14
Cellular changes associated with Herpes simplex virus 16
Other
Reactive Changes 18
Reactive Cellular Changes Associated With:
Inflammation (includes typical repair) 18
Atrophy with inflammation ("atrophic vaginitis") 22
Radiation 24
Intrauterine contraceptive device (IUD) 26
Other
Epithelial Cell Abnormalities 30
Squamous Cell 30
Atypical squamous cells of undetermined significance
(ASCUS): Qualify 30
vi The Bethesda System
Low-grade squamous intraepithelial lesion (LSIL) 44
Encompassing: Human papillomavirus (HPV)/mild
dysplasia/cervical intraepithelial neoplasia (CIN) 1
High-grade squamous intraepithelial lesion (HSIL) 48
Encompassing: Moderate dysplasia, severe dysplasia,
and carcinoma in situ/CIN 2 and CIN 3
Squamous cell carcinoma 60
Glandular Cell 62
Endometrial cells, cytologically benign, in a postmenopausal
woman 62
Atypical glandular cells of undetermined significance
(AGUS): Qualify 64
Endocervical adenocarcinoma 74
Endometrial adenocarcinoma 76
Extrauterine adenocarcinoma 78
Adenocarcinoma, NOS
Other Malignant Neoplasms 81
Contributors
Robert J. Kunnan, M.D. *t
Chainnan, Criteria Committee
Johns Hopkins University, Baltimore, MD
Ronald D. Luff, M.D., M.P.H.*
Chainnan, Editorial Committee
Sacred Heart Hospital, Allentown, PA
Barbara F. Atkinson, M.D.t
Medical College of Pennsylvania, Philadelphia, PA
Jonathan S. Berek, M.D. *
University of California at Los Angeles School of Medicine,
Los Angeles, CA
Marluce Bibbo, M.D., Sc.D.*
Thomas Jefferson University, Philadelphia, PA
Thomas A. Bonfiglio, M.D. t
University of Rochester, Rochester, NY
Christopher P. Crum, M.D. t
Brigham and Women's Hospital, Boston, MA
Yener S. Erozan, M.D.t
Johns Hopkins University, Baltimore, MD
Yao Shi Fu, M.D.t
University of California at Los Angeles, Los Angeles, CA
Shirley E. Greening, M.S., J.D.*
Thomas Jefferson University, Philadelphia, PA
Michael R. Henry, M.D.t
National Naval Medical Center, Bethesda, MD
Donald E. Henson, M.D. *
National Cancer Institute, Bethesda, MD
Mujtaba Husain, M.D. t
Sinai Hospital, Detroit, MI
Robert V. P. Hutter, M.D.*
St. Barnabas Medical Center, Livingston, NJ
Stanley L. Inhorn, M.D. *
University of Wisconsin, Madison, WI
viii The Bethesda System
Howard W. Jones ill, M.D. *
Vanderbilt University Medical Center, Nashville, TN
Nancy B. Kiviat, M.D.t
University of Washington, Seattle, WA
Tilde S. Kline, M.D. t
Lankenau Hospital, Wynnewood, PA
Paul A. Krieger, M.D. *
MetPath Inc., Teterboro, NJ
George D. Malkasian, Jr., M.D. *
Mayo Clinic, Rochester, MN
Alexander Meisels, M.D. t
Hopital du Saint-Sacrement, Quebec City, PQ
Mary L. Nielsen, M.D.*
Pathology Consultants, Wichita, KS
Stanley F. Patten, Jr., M.D., Ph.D.
University of Rochester, Rochester, NY
Vincent P. Perna, M.D. *
SmithKline Beecham Laboratories, St. Louis, MO
Dorothy L. Rosenthal, M.D. *
University of California at Los Angeles School of Medicine,
Los Angeles, CA
Patricia E. Saigo, M.D. *
Memorial Sloan-Kettering Cancer Center, New York, NY
Alexander Sedlis, M.D. *
State University of New York Health Science Center at Brooklyn,
Brooklyn, NY
Mark E. Sherman, M.D.
Johns Hopkins University, Baltimore, MD
Diane Solomon, M.D. *t _
National Cancer Institute, Bethesda, MD
Theresa Somrak, C.T.(ASCP), J.D.
Cytopathology Education Consortium, Chicago, IL
Leo B. Twiggs, M.D. *
University of Minnesota, Minneapolis, MN
George L. Wied, M.D.*
University of Chicago, Chicago, IL
*Denotes members of The Bethesda System Editorial Committee
tDenotes members of The Bethesda System Criteria Committee
Introduction
The Bethesda System (TBS) for Reporting CervicaVVaginal Cytologic
Diagnoses was developed at a National Cancer Institute (NCI)-sponsored
workshop in December 1988 to provide uniform diagnostic terminology
that would facilitate communication between the laboratory and the
clinician. The format ofTBS report includes a descriptive diagnosis and an
evaluation of specimen adequacy. TBS was designed to be flexible so that
it could evolve in response to changing needs in cervical cancer screening
as well as to advances in the field of cervical pathology. Subsequently, a
second workshop was held in April 1991 to evaluate the impact of TBS in
actual practice and to amend and modify it where needed. One of the major
recommendations of this second meeting was that precise criteria should be
formulated for both the diagnostic terms and for the descriptors of
specimen adequacy. That is the intended purpose of this monograph.
The classification used in TBS is not a histogenetic one, but rather a
nomenclature designed to facilitate categorization and reporting of cyto
logic diagnoses. The overall diagnosis, as in the World Health Organiza
tion (WHO) system, is based on the most abnormal cells present regardless
of their number. In addition, it should be noted that the site of origin of an
abnormality detected in a cervicaVvaginal cytologic sample cannot always
be specified because morphologically identical tumors may arise in the
vagina, cervix, endometrium, or ovary.
The criteria and descriptions provided in this monograph are intended to
supplement the classification and are not meant to be a comprehensive
treatise on gynecologic cytopathology. For a detailed discussion the reader
is directed to several comprehensive cytopathology textbooks. Use of these
criteria should facilitate uniform application of TBS and result in more
consistent reporting of cytologic diagnoses. However, it should be empha
sized that cervicaVvaginal cytopathology includes an element of subjective
interpretation and consequently the application of these criteria should be
viewed within this context.
The Bethesda
System
Part 1
Specimen Adequacy
Definitions, Criteria, and Explanatory Notes